RESPONSE

How does middle range theory illuminate concepts in health and health care delivery?

Middle range nursing theories illuminate health and healthcare concepts that are most applicable to nursing practice within disciplinary confines. These theories are more intervention and treatment related and are more popular for developing research frameworks; middle range theories are more related to the practice issues facing nurses in their daily encounters in the health care environment (Gray, Grove & Sutherland 2017). This arena of nursing research highlights concepts in contemporary nursing that are the result of gaps in practice, theory and discipline that are the result of failed application of older grand theories of nursing. Middle range nursing theories identify and bridge gaps between research and practice by presenting theories based on empirical evidence generated by application of evidence to everyday practice (Brandão et al., 2018). Middle range theories affirm the use of evidence translated into practice that is now the hallmark of nursing best practices also known as evidence-based practice (McEwin & Wills 2019). These nursing theories present gaps in practice application generated by older thinking discovered by nursing grand theories; the new knowledge generated from these gaps are the basis for middle range nursing theories and concepts.

•What do you see as your particular role in developing (or evaluating) middle range theories? Why might that be important to advancing nursing science and improving clinical practice?

The key elements of middle range nursing theories is their ability to be tested, reliable and concrete. Whereas grand nursing theories rely on abstract concepts that directed research, middle range theories are more linked to current issues in practice that are the results of gaps in knowledge produced by these abstract concepts (McEwin & Wills 2019). With this in mind, the role that nurses have in the development of middle range theories is identification of knowledge gaps and practice gaps generated by grand nursing theories as well as testing concepts for development into changes in clinical practice (Fawcett & Garity 2009). Middle range research frameworks are more specifically directed towards interventions that effect patient outcomes through research development and application and have less reliance on abstract concepts. As a result of there direct connection to everyday practice issues, the use and development of evidence-based practice, middle range nursing theories are more important to advancing nursing science through application and development of new knowledge that adds to the discipline.

Reference:

Brandão, M. A. G., Martins, J. S. de A., Peixoto, M. de A. P., Lopes, R. O. P., & Primo,C. C. (2018). REFLEXÕES TEÓRICAS E METODOLÓGICAS PARA A CONSTRUÇÃO DE TEORIAS DE MÉDIO ALCANCE DE ENFERMAGEM. Texto & Contexto - Enfermagem, 26(4). https://doi.org/10.1590/0104-07072017001420017

Fawcett J, & Garity J. (2009). Chapter 6: evaluation of middle-range theories. In Evaluating Research for Evidence-Based Nursing (pp. 73–88). F.A. Davis Company/Publishers.

‌Gray, J.R., Grove, S.K. & Sutherland, S. (2017). Burn’s and Grove’s The Practice of Nursing Research: appraisal, synthesis and generation of evidence (8th ed.) St. Louis, MO: Saunders Elsevier.

McEwin, M. & Wills, E.M. (2019). Theoretical basis for nursing. (5th ed) Philadelphia, PA: Wolters Kluwer Health.